Purpose: Osteopenia typically presents low bone mineral density (BMD) and has recently been reported as a prognostic factor in various cancers. However, the prognostic value of osteopenia in digestive tract cancers remains to be defined. We aimed to review the prognostic value of preoperative osteopenia in patients with digestive cancers. Methods: Cohort studies evaluating the prognostic value of preoperative osteopenia in digestive cancers (colorectal, esophageal, hepatic, bile duct, and pancreatic cancer) were searched using electronic databases and trial registries. The exposure was defined as low BMD estimated by computed tomography at 11^th thoracic vertebra, while comparator was normal BMD. The primary outcomes were overall survival and recurrence-free survival for osteopenia. Random effect meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence. Results: A total of 11 studies (2230 patients) were included. Osteopenia was an independent risk factor for overall survival (hazard ratio [HR] = 2.02, 95% CI = 1.47 to 2.78; I² = 74%), along with sarcopenia. Osteopenia also predicted poor recurrence-free survival (HR = 1.96, 95% CI = 1.36 to 2.81; I² = 85%). In subgroup analyses, osteopenia predicted prognosis in colorectal, esophageal, hepatic, and bile duct cancers, but not in pancreatic cancer. The certainty of the evidence was low due to inconsistency and publication bias. Conclusion: Osteopenia may be independently associated with poor prognosis in patients with digestive tract cancer. Further studies are needed to establish the relevance of osteopenia in the operative prognosis of these patients.

Background: Malpositioning of the acetabular cup during total hip arthroplasty (THA) can lead to complications. Robotic surgery and navigation techniques aim to address this issue, but there is limited evidence regarding which method can achieve better clinical outcomes. Therefore, this network meta-analysis (NMA) aimed to compare the efficacy of various navigation methods. Methods: This NMA of prospective randomized controlled trials compared robot-assisted systems (RAS), computer-assisted navigation systems (CAS), augmented reality-based portable navigation (AR), patient-specific instrumentation (PSI), portable accelerometer-based navigation (PN), and conventional methods (C) for THA procedures. We searched MEDLINE, EMBASE, Cochrane, Central Register of Controlled Trials, International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. databases. The primary outcomes included revision surgery and postoperative clinical scores, and the secondary outcomes encompassed cup placement accuracy, acetabular cup placement outliers from the Lewinnek safe zone, surgical time, and complications. We used a Bayesian random-effects NMA, and confidence of evidence was assessed using confidence in NMA. Results: We identified 45 studies including 2,122 patients. We did not find large differences in revision surgery, clinical outcome scores, cup inclination, or anteversion angle accuracy among the modalities. AR, CAS, and PSI exhibited a lower risk of outliers from safe zones than C. In addition, RAS and CAS had a longer surgical time than C. Conclusions: Robotic and navigation tools did not reduce the revision risk or enhance clinical outcomes. AR, CAS, PSI, and PN may decrease the risk of cup placement outliers in safe zones. However, the cup placement accuracy was equivalent, and the surgical time may be longer in RAS and CAS than in C. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Purpose: This study aimed to clarify lower limb alignment characteristics and the relationship between coronal and sagittal lower limb alignment in Japanese patients with knee complaints but without knee osteoarthritis (KOA).Methods: This retrospective study included 200 knees from Japanese patients with knee complaints but without KOA aged 60 years and under presenting with knee complaints between May 2020 and May 2023. We assessed coronal parameters, including mechanical hip knee angle (mHKA), arithmetic HKA (aHKA) mechanical lateral distal femoral angle and medial proximal tibial angle (MPTA), and sagittal parameters, such as medial posterior tibial slope (MPTS) and lateral posterior tibial slope (LPTS). In addition, we compared differences between CPAK types.Results: A weak positive correlation was found between mHKA and MPTS, but not with aHKA. Moderate negative and moderate positive correlations were found between mHKA and MPTA and between medial and LPTS, respectively.Conclusions: Little correlation was found between the coronal and sagittal parameters in patients with knee complaints but without KOA.Level of Evidence: Level Ⅲ.

A 66‐year‐old Japanese woman presented with upper abdominal pain and nausea after having eaten several rice cakes. An abdominal CT scan showed retained rice cakes in the stomach, which led to intestinal obstruction three days later.

Background: Orthopaedic infections are difficult to eradicate because biofilm and poor local vascularity limit antibiotic exposure. Continuous local antibiotic perfusion (CLAP) delivers sustained, titratable antibiotics directly into infected compartments. We used harmonised individual participant data (IPD) to quantify early effectiveness, longer-term control, safety, and patient-level modifiers. Methods: We performed an IPD review of observational reports using CLAP as primary or adjunctive therapy (January–May 2025). The primary outcome was 30-days early response (C-reactive protein ≤3 mg/L or earliest sustained clinical/wound improvement). Secondary outcomes were durable infection control at ≥6 and ≥12 months using evaluable denominators with best–worst bounds, infection-free days) and safety. One-stage analyses used mixed-effects logistic regression; Restricted Mean Survival Time (RMST) was preferred when proportional hazards were violated. Multiple imputation supported inferences. Results: Eighty-one studies ( n = 256) were included; 164 patients had observed time-to-response. Fifty-nine percent achieved a 30-days response; median time-to-response was 26 days. Implant involvement was associated with lower odds of 30-days response; trajectories were slower with implants and higher organism burden (polymicrobial ≥3), while osteomyelitis responded faster than fracture-related infection. RMST (30) showed delays with implants (+4.43 days) and polymicrobial infection (+6.74 days), and faster response for osteomyelitis versus fracture-related infection (−9.06 days). Durable control among evaluable patients was 88.4% at ≥6 months and 90.2% at ≥12 months, with best–worst bounds of 89.2–82.2% and 90.9–83.5%, respectively. Infection-free-day RMST supported substantial time free of recurrent infection within the first year. Adverse events were uncommon; renal events were generally reversible. Conclusions: CLAP achieved encouraging early response and high durability among evaluable patients, with slower trajectories when implants were retained or pathogen burden was high and faster responses in osteomyelitis. Safety appeared acceptable with monitoring. Prospective comparative studies using standardised endpoints, with RMST for non-proportional hazards, are warranted.